Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.

Background There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice. Methods A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes. Results Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions. Conclusion Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.

The objective of this study was to evaluate the efficacy of an in-service, short-term training program in improving the attitudes toward, and readiness and activities for collaboration among community health workers (CHWs) in a primary care setting in the Philippines. A randomized controlled trial was adopted dividing participants into an intervention (n = 42) and a control group (n = 39). Attitudes toward, and readiness and activities for collaboration were measured using three standardized scales before and at 6 months after the training. A significant difference (p < 0.001) was observed in the Attitudes Toward Health Care Teams Scale (ATHCTS) scores between pre- and post-test in the intervention (6.3 ± 8.3 [Mean ± SD]) and control groups (0.7 ± 8.2). Multivariate linear regression analysis showed an independent positive association between the intervention and greater improvement in the ATHCTS score (Coefficient β = 6.17; 95% CI = 0.82, 11.53; p = 0.03) at follow-up, after adjustment for age, years in current occupation, and social support role of participants. The results demonstrated the efficacy of the intervention for improving the attitudes of CHWs toward collaborative practice in the care of older adults.

The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.

Background A growing number of older adults require complex care, but coordination among professionals to provide comprehensive and high-quality care is perceived to be inadequate. Opportunities to gain the knowledge and skills important for interprofessional collaboration in the context of geriatric care are limited, particularly for those already in the workforce. A short-term training programme in interprofessional collaboration for health and social care workers in the Philippines was designed and pilot tested. The programme was devised following a review of the literature about geriatric care education and group interviews about training needs. The objectives of this paper are to introduce the training programme and to evaluate its influence on attitudes and readiness to collaborate among participants using both quantitative and qualitative methodologies. Methods A total of 42 community health workers and 40 health institution workers participated in the training in July 2019. Quantitative indicators were used to evaluate attitudes towards and readiness for collaboration before and after the training. Content analysis was performed of responses to open-ended questions asking participants to evaluate the training. A convergent parallel mixed-methods design was applied to determine the patterns of similarities or differences between the quantitative and qualitative data. Results Significant improvements were seen in scores on the Attitudes Towards Health Care Teams Scale among community health (P < 0.001) and health institution (P < 0.001) staff after the training. Scenario-based case studies allowed participants to work in groups to practise collaboration across professional and institutional boundaries; the case studies fostered greater collaboration and continuity of care. Exposure to other professionals during the training led to a deeper understanding of current practices among health and social care workers. Use of the scenario-based case studies followed by task-based discussion in groups was successful in engaging care professionals to provide patient-centred care. Conclusions This pilot test of in-service training in interprofessional collaboration in geriatric care improved community and health institution workers’ attitudes towards such collaboration. A 3-day training attended by health and social care workers from diverse healthcare settings resulted in recommendations to enhance collaboration when caring for older adults in their current work settings.

Background. New findings on the detrimental health effects of electronic nicotine delivery system (ENDS)/ electronic non-nicotine delivery system (ENNDS) confounds the “harm reduction” perspective of using it as an alternative to conventional cigarettes. In the Philippines, the pressing debate on its safety and efficacy had initiated actions from policy makers on legislative issues such as draft DOH Administrative Order, House Bill 4325 and House Bill 532. Objective. The study aimed to craft an evidence-based policy position on the regulation of ENDS/ENNDS. Method. Review of literature was conducted, and the proposed scope and measures on electronic cigarette regulation were compared with WHO Framework Convention on Tobacco Control (WHO-FCTC) and existing policies of US FDA regulations on ENDS. Further, UP Manila convened experts of various related fields for evidence-based review and discussion of policy issues to arrive at a consensus policy statement and recommendations. Results. Findings showed that ENDS/ENNDS still need further research to have conclusive results on long term safety and efficacy as smoking cessation methods. Conclusion. Regulations for tobacco control should be clear and supported with strict guidelines in manufacturing, distribution, advertisement, selling, and usage restrictions in public. With the current review, it is recommended that ENDS/ENNDS regulation be under the mandate of the FDA in alignment to WHO-FCTC and to engage different stakeholders from policy makers, implementers, and other involved organizations.

Background. The College of Public Health, University of the Philippines Manila (CPH-UPM) was engaged by the Center for Health Development Calabarzon (CHD 4A) to design, implement and manage the retooling of their personnel following implementation of Executive Order No. 336 on the rationalization of the Philippine government's executive branch. Objective. To describe the training design and present outputs of the training modules designed for the CHD 4A staff. Methods. We reviewed the project documentation, which included the inception report, minutes of meetings, training modules, and post-training reports. Abstracted information was validated through internal discussion by a core group, which had representatives from the two organizations involved from project inception to close-out. Results. The design, development and implementation of the training were the product of collaborative efforts between CHD 4A and the technical team from the College of Public Health, University of the Philippines Manila. Technical staff of CHD 4A were trained in the competency areas in which gaps between the expected and perceived level of performance across all salary grades were highest: results orientation, planning and organizing, technical expertise, quality service focus, coordination and networking, and managing change. Nine training courses were implemented from May to July 2016, which was attended by 230 participants. All training modules were highly rated by participants (range: 3.60 to 3.85) based on a four-point scale, with 4 as the highest rating and 1 as the lowest. Comparison of pre-and post-tests for the modules on coordination and networking, and managing change showed a statistically significant increase in scores at the conclusion of their respective sessions. Conclusion. The design of a training program for an organization's personnel must be tailor-fit to and answer the needs of its employees. Trainers must be willing to make dynamic changes and adapt to immediate feedback from participants. The implementing party and organization itself must both ensure thorough evaluation of the effects of the training to achieve the organization's long-term goals.

Objective. Despite the provision of local health policies promoting the utilization of sexual and reproductive health (SRH) services of adolescents, SRH services utilization remains very low and little information is known concerning the factors which may influence adolescents' use of these SRH services. This study aimed to determine the prevalence and determinants of school-based SRH services utilization among secondary school students. Materials and Methods. This is a cross-sectional study that used a self-administered questionnaire to gather data among students in one public secondary school in the City of Dasmariñas. A total of 24 sections from Grades 8 to 12 were randomly selected using stratified cluster sampling. Both descriptive and inferential statistics were used to analyze the data using Epi Info version 7.3.2.1.Results. Among 1,218 students who answered the questionnaire, 168 students (13.8%) utilized the SRH services in the Teen Health Kiosk (THK) during SY 2019-20. Students with favorable attitudes towards SRH issues (predisposing factor) were twice more likely to utilize the SRH services (Adjusted odds ratio, AOR 1.75, 95% CI 1.12-2.74) and those who have positive perceived accessibility on the SRH services (enabling factor) were 2.5 times more likely to utilize the SRH services (AOR 2.46, 95% CI 1.66 -3.66). Conclusion.Attitudes towards SRH issues and perceived accessibility to SRH services were found to be determinants of SRH services utilization in the THK of the selected public secondary school in the City of Dasmariñas. Even with the marked increase in the utilization of SRH services in the THK from 0.2% in SY 2018-19 to 13.8% in SY 2019-20, intensified efforts are still needed in order to target students' attitudes on SRH and accessibility of THK and the SRH services it offers to its clients. It is recommended that the existing THK Club be strengthened as this will play a significant role in changing the attitudes of students towards SRH issues, thus increasing the utilization of SRH services. Additionally, formulating an SRH policy at the school level targeting THK's accessibility will be helpful in increasing the utilization of school-based SRH services. For one, a policy mandating THK service providers to deliver services beyond school hours may be discussed such that it can also cater students who are attending the school during weekends (i.e. ALS students, Open High students). Likewise, policy makers in the City Schools Division Office including their top management and personnel from the Health and Nutrition Unit as well as school administrators must endeavor to provide a more conducive THK where privacy and confidentiality can be maintained at all times and clients can freely discuss SRH issues with the THK service provider. An initiative to provide a separately detached room for the THK is encouraged in order to provide a more suitable counselling area and to ensure privacy and confidentiality of student clients and their shared information.